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r <br /> verizon <br /> Invoice Number Account Number Date Due Page <br /> 9783762439 842149037-00001 05/05/17 2 of 5 <br /> Get Minutes Used Get Data Used Get Balance <br /> #MIN+SEND #DATA+SEND #BAL+SEND <br /> Payments <br /> Previous Balance $,00 <br /> No Payment Received <br /> Total Payments too <br /> Balance Forward $,00 <br /> • <br /> Written notations included with or on your payment will not be reviewed or honored. Please send correspondence to: <br /> Verizon Wireless Attn: Correspondence Team P.O. Box 291089 Columbia, SC 29229 <br /> AAutomatic Payment Enrollment for Account:842149037-00001 NVLPT-OR-CITY-EUGENE <br /> By signing below,you authorize Verizon Wireless to electronically debit your bank account each month for the total balance due on your account.The check you send will be used to <br /> setup Automatic Payment.You will be notified each month of the date and amount of the debit 10 days in advance of the payment. I understand and accept these terms. This <br /> agreement does not alter the terms of your existing Customer Agreement.I agree that Verizon Wireless is not liable for erroneous bill statements or incorrect debits to my account.To <br /> withdraw your authorization you must call Verizon Wireless.Check with your bank for any charges. <br /> 1.Check this box. 2.Sign name in box below,as shown on the bill and date. 3.Return this slip with your payment.Do not send a voided check. <br /> ULI ■ <br /> 001 7280-0064800-0000002 of 0000006-C11-LT-6010-17297 <br />